Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
  • A61K31/352—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom condensed with carbocyclic rings, e.g. methantheline 
  • A61K31/353—3,4-Dihydrobenzopyrans, e.g. chroman, catechin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
  • A61K31/52—Purines, e.g. adenine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration

Definitions

• the present invention relates to the use of a dual selective PI3K delta and gamma protein kinase inhibitor, such as (S)-2-(l-((9H-purin-6-yl)amino)propyl)-3-(3- fluorophenyl)-4H-chromen-4-one (Compound (A), also known as tenalisib) or a pharmaceutically acceptable salt thereof or a pharmaceutical composition containing such an inhibitor for the treatment of peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL).
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T-cell lymphoma
• Lymphoma is the most common blood cancer.
• the two main forms of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL).
• Lymphoma occurs when cells of the immune system called lymphocytes, a type of white blood cell, grow and multiply uncontrollably. Cancerous lymphocytes can travel to many parts of the body, including the lymph nodes, spleen, bone marrow, blood, or other organs, and form a mass called a tumor.
• the body has two main types of lymphocytes that can develop into lymphomas: B -lymphocytes (B -cells) and T-lymphocytes (T-cells).
• B -lymphocytes B -lymphocytes
• T-cells T-cell lymphomas account for approximately 15 percent of all NHLs in the United States. There are many different forms of T-cell lymphomas, some of which are extremely rare. Most T-cell lymphomas can be classified into two broad categories: aggressive (fast
• Peripheral T-cell lymphoma consists of a group of rare and usually aggressive (fast-growing) NHLs that develop from mature T-cells. Most T-cell lymphomas are PTCLs, which collectively account for about 10 percent to 15 percent of all NHL cases in the United States.
• PTCLs are sub-classified into various subtypes, each of which are typically considered to be separate diseases based on their distinct clinical differences. Most of these subtypes are very rare; the three most common subtypes of PTCL, peripheral T-cell lymphoma not otherwise specified (PTCL-NOS), anaplastic large-cell lymphoma (ALCL), and angioimmunoblastic T-cell lymphoma (AITL), account for approximately 70 percent of all PTCLs in the United States.
• PTCL NOS Peripheral T-cell lymphoma not otherwise specified
• PTCL NOS refers to a group of diseases that do not fit into any of the other subtypes of PTCL.
• PTCL-NOS is the most common PTCL subtype, making up about one quarter of all PTCLs. It is also the most common of all the T-cell lymphomas.
• the term PTCL can be confusing as it can refer to the entire spectrum of mature T-cell lymphomas, but it can also refer to the specific PTCL-NOS subtype.
• most patients with PTCL-NOS are diagnosed with their disease confined to the lymph nodes, sites outside the lymph nodes, such as the liver, bone marrow, gastrointestinal tract, and skin, may also be involved. This group of PTCLs is aggressive and requires combination chemotherapy upon diagnosis.
• Anaplastic large-cell lymphoma is an aggressive T-cell lymphoma, accounting for about three percent of all lymphomas in adults (about 15 percent to 20 percent of all PTCLs) and between 10 percent and 30 percent of all lymphomas in children.
• ALCL can appear in the skin or in other organs throughout the body (systemic ALCL).
• ALCL has several different subtypes, each with different expected outcomes and treatment options.
• Angioimmunoblastic T-cell lymphoma is an aggressive T-cell lymphoma that accounts for about two percent of all NHL cases (about 10 percent to 15 percent of all PTCLs) in the United States. This type of lymphoma often responds to milder therapies, such as steroids, although it often progresses and requires chemotherapy and other medications. In advanced cases, bone marrow transplantation may be used.
• Cutaneous T-cell lymphomas are a group of lymphomas that originate in the skin. CTCLs are a subset of PTCL because they are lymphomas of mature T-cells. However, these lymphomas are generally less aggressive, have a different prognosis, and have different treatment approaches than the aggressive PTCLs.
• Enteropathy- type T-cell lymphoma is an extremely rare subtype of PTCL that appears in the intestines and is strongly associated with celiac disease.
• Nasal NK/T-Cell lymphoma involves natural killer (NK) cells, which are closely related to and often have features that overlap with T-cells. Although this aggressive lymphoma is very rare in the United States, it is more common in Asia and parts of Latin America, leading researchers to suspect that some ethnic groups may be more prone to this cancer. This type of lymphoma is associated with the Epstein-Barr virus and often involves the nasal area, trachea, gastrointestinal tract, or skin.
• Hepatosplenic gamma-delta T-cell lymphoma is an extremely rare and aggressive disease that starts in the liver or spleen.
• Many new drugs are being studied in clinical trials for the treatment of PTCL, including alemtuzumab (Campath), alisertib (MLN8237), bortezomib (Velcade), brentuximab vedotin (Adcetris), carfilzomib (Kyprolis), dasatinib (Sprycel), E7777, fludarabine (Fludara), lenalidomide (Revlimid), nelfinavir (Viracept), panobinostat (LBH-589), pralatrexate (Folotyn), romidepsin (Istodax), temsirolimus (Torisel) and vorinostat (Zolinza).
• Vaccine therapy is also being investigated in clinical trials.
• CTCF cutaneous T-cell lymphoma
• Symptoms can include dry skin, itching (which can be severe), a red rash, and enlarged lymph nodes.
• the disease affects men more often than women and usually occurs in men in their 50s and 60s.
• Most patients with CTCF experience only skin symptoms, without serious complications; however, approximately 10 percent of those who progress to later stages develop serious complications.
• Early stage CTCF is typically indolent; some patients with early-stage CTCF might not progress to later stages at all, while others might progress rapidly, with the cancer spreading to lymph nodes and/or internal organs.
• CTCF describes many different disorders with various symptoms, outcomes, and treatment considerations. The two most common types are mycosis fungoides and Sezary syndrome.
• Mycosis fungoides is the most common type of CTCF, with approximately 16,000 to 20,000 cases across the United States, accounting for half of all CTCFs.
• the disease looks different in each patient, with skin symptoms that can appear as patches, plaques, or tumors. Patches are usually flat, possibly scaly, and look like a rash; plaques are thicker, raised, usually itchy lesions that are often mistaken for eczema, psoriasis, or dermatitis; and tumors are raised bumps, which may or may not ulcerate. It is possible to have more than one type of lesion.
• a medical history, physical exam, and skin biopsy are used for diagnosis.
• a physician will examine lymph nodes, order various blood tests, and may conduct other screening tests, such as a chest x-ray or a computed axial tomography (CAT) scan. Scans are usually not needed for those with the earliest stages of the disease. Mycosis fungoides is difficult to diagnose in its early stages because the symptoms and skin biopsy findings are similar to those of other skin conditions.
• CAT computed axial tomography
• Sezary syndrome is an advanced, variant form of mycosis fungoides, which is characterized by the presence of lymphoma cells in the blood. Extensive thin, red, itchy rashes usually cover over 80 percent of the body. In certain patients, patches and tumors appear. Patients may also experience changes in the nails, hair, or eyelids, or have enlarged lymphnodes. Many of the same procedures used to diagnose and stage other types of cutaneous T-cell lymphomas are used in Sezary syndrome. In addition, a series of imaging tests may be needed to determine if the cancer has spread to the lymph nodes or other organs (although that uncommonly occurs). These tests may include a CAT scan, a positron emission tomography (PET) scan, and/or a magnetic resonance imaging(MRI) scan. A bone marrow biopsy may also be done, but is usually not necessary.
• PET positron emission tomography
• MRI magnetic resonance imaging
• Phosphoinositide-3 kinase belongs to a class of intracellular lipid kinases that phosphorylate the 3 position hydroxyl group of the inositol ring of phosphoinositide lipids (Pis) generating lipid second messengers. While alpha and beta isoforms are ubiquitous in their distribution, expression of delta and gamma is restricted to circulating hematogenous cells and endothelial cells. Unlike PI3K-alpha or beta, mice lacking expression of gamma or delta do not show any adverse phenotype indicating that targeting of these specific isoforms would not result in overt toxicity.
• PI3K phosphoinositide-3-kinase
• PIP3 phosphatidylinositol (3,4,5)-trisphosphate
• PIP3 recruits proteins to the cytoplasmic side of the lipid bilayer, including protein kinases and GTPases, initiating a complex network of downstream signaling cascades important in the regulation of immune cell adhesion, migration, and cell-cell communication.
• PI3Ka and RI3Kb are ubiquitous and activated downstream of receptor tyrosine kinases (RTK), whereas PI3K d and PI3K g are primarily limited to hematopoietic and endothelial cells, and are activated downstream of RTKs, and G protein coupled receptors (GPCR), respectively.
• RTK receptor tyrosine kinases
• GPCR G protein coupled receptors
• the present invention relates to the use of a dual selective PI3K delta and gamma inhibitor for treating peripheral T-cell lymphoma (PTCL) and cutaneous T- cell lymphoma (CTCL).
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T- cell lymphoma
• One embodiment is the use of a dual selective PI3K delta and gamma inhibitor for the treatment of peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL).
• a preferred embodiment is the use of (S)-2-(l-((9H-purin-6-yl)amino)propyl)-3-(3- fluorophenyl)-4H-chromen-4-one or a pharmaceutically acceptable salt thereof for the treatment of peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL).
• the dual selective PI3K delta and gamma inhibitor may be administered as a front-line therapy or as a relapsed-refractory therapy for the treatment of a peripheral T-cell lymphoma (PTCL).
• the dual selective PI3K delta and gamma inhibitor may be administered as a front-line therapy or as a relapsed-refractory therapy for the treatment of a cutaneous T-cell lymphoma (CTCL).
• CTCL cutaneous T-cell lymphoma
• Another embodiment is a method of treating a peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL) in a subject (preferably a human subject) comprising administering to the subject an effective amount of a dual selective PI3K delta and gamma inhibitor.
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T-cell lymphoma
• a preferred embodiment is a method of treating a peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL) in a subject (preferably a human subject) comprising administering to the subject (preferably a human subject) an effective amount of Compound (A) or a pharmaceutically acceptable salt thereof.
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T-cell lymphoma
• Yet another embodiment is a method of inhibiting PI3K delta and gamma activity in a subject (preferably a human subject) suffering from a Peripheral T-cell lymphoma (PTCL) or Cutaneous T-cell lymphoma (CTCL) by administering to the subject an effective amount of a dual selective PI3K delta and gamma inhibitor.
• a subject preferably a human subject
• CTCL Cutaneous T-cell lymphoma
• the dual selective PI3K delta and gamma inhibitor is Compound (A) or a pharmaceutically acceptable salt thereof.
• An object of the present invention relates to the uses described herein for the treatment of a subject, in particular of a human subject.
• An object of the present invention is the use of Compound (A) or a pharmaceutically acceptable salt thereof for the preparation of a medicament intended for the treatment of a peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL).
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T-cell lymphoma
• Another object of the present invention is the use of Compound (A) or a pharmaceutically acceptable salt thereof for the preparation of a medicament intended for the treatment of a peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL), where the medicament is administered orally.
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T-cell lymphoma
• the dual selective PI3K delta and gamma inhibitor can be administered to the subject by the oral route, the intravenous route, the intramuscular route, or the intraperitoneal route. In one preferred embodiment, the dual selective PI3K delta and gamma inhibitor is administered orally. [36] In one embodiment, the dual selective PI3K delta and gamma inhibitor, such as Compound (A) or a pharmaceutically acceptable salt thereof, is administered as a front-line therapy for a peripheral T-cell lymphoma (PTCL).
• PTCL peripheral T-cell lymphoma
• the dual selective PI3K delta and gamma inhibitor such as Compound (A) or a pharmaceutically acceptable salt thereof, is administered as a relapsed- refractory therapy for a peripheral T-cell lymphoma (PTCL).
• PTCL peripheral T-cell lymphoma
• the dual selective PI3K delta and gamma inhibitor such as Compound (A) or a pharmaceutically acceptable salt thereof, is administered as a front-line therapy for a cutaneous T-cell lymphoma (CTCL).
• CTCL cutaneous T-cell lymphoma
• the dual selective PI3K delta and gamma inhibitor such as Compound (A) or a pharmaceutically acceptable salt thereof, is administered as a relapsed- refractory therapy for a cutaneous T-cell lymphoma (CTCL).
• CTCL cutaneous T-cell lymphoma
• the dual selective PI3K delta and gamma inhibitor is used in combination (administered together or sequentially) with an anti-cancer treatment, one or more cytostatic, cytotoxic or anticancer agents, targeted therapy, or any combination or any of the foregoing.
• Suitable anti-cancer treatments include, e.g., radiation therapy.
• Suitable cytostatic, cytotoxic and anticancer agents include, but are not limited to, DNA interactive agents, such as cisplatin or doxorubicin; topoisomerase II inhibitors, such as etoposide; topoisomerase I inhibitors such as CPT-l l or topotecan; tubulin interacting agents, such as paclitaxel, docetaxel or the epothilones (for example, ixabepilone), either naturally occurring or synthetic; hormonal agents, such as tamoxifen; thymidilate synthase inhibitors, such as 5- fluorouracil; and anti-metabolites, such as methotrexate, other tyrosine kinase inhibitors such as gefitinib (marketed as Iressa ® ) and erlotinib (also known as OSI-774); angiogenesis inhibitors; EGF inhibitors; VEGF inhibitor
• Yet another embodiment is Compound (A) or a pharmaceutically acceptable salt thereof for use in the front-line therapy of a peripheral T-cell lymphoma (PTCL).
• PTCL peripheral T-cell lymphoma
• Yet another embodiment is Compound (A) or a pharmaceutically acceptable salt thereof for use in the relapsed-refractory therapy of a peripheral T-cell lymphoma (PTCL).
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T-cell lymphoma
• Yet another embodiment is Compound (A) or a pharmaceutically acceptable salt thereof for use in the relapsed-refractory therapy of a cutaneous T-cell lymphoma (CTCL).
• CTCL cutaneous T-cell lymphoma
• Yet another embodiment is a pharmaceutical composition for treating a peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL) comprising a dual selective PI3K delta and gamma inhibitor (preferably Compound (A) or a pharmaceutically acceptable salt thereof), and optionally one or more pharmaceutically acceptable carriers or excipients.
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T-cell lymphoma
• a dual selective PI3K delta and gamma inhibitor preferably Compound (A) or a pharmaceutically acceptable salt thereof
• pharmaceutically acceptable carriers or excipients optionally one or more pharmaceutically acceptable carriers or excipients.
• the pharmaceutical composition further comprises one or more cytostatic, cytotoxic or anticancer agents.
• the pharmaceutical composition is useful in combination with one or more anti-cancer treatments, one or more cytostatic, cytotoxic or anticancer agents, targeted therapy, or any combination or any of the foregoing.
• the dual selective PI3K delta and gamma inhibitor may be used together or sequentially with one or more anti-cancer treatments one or more cytostatic, cytotoxic or anticancer agents, targeted therapy, or any combination or any of the foregoing.
• the pharmaceutical composition of the dual selective PI3K delta and gamma inhibitor (preferably Compound (A) is suitable for oral administration.
• Compound (A) or a pharmaceutically acceptable salt thereof is administered at a dose of about 25 to about 2000 mg, such as a dose of about 25 to about 1600 mg, about 25 to about 1200 mg, about 25 to about 800 mg, about 25 to about 600 mg, or about 25 to about 400 mg.
• Compound (A) or a pharmaceutically acceptable salt thereof is administered at a dose of about 50 to about 2000 mg, such as a dose of about 50 to about 1600 mg, about 50 to about 1200 mg, about 50 to about 800 mg, about 50 to about 600 mg, or about 50 to about 400 mg.
• Compound (A) or a pharmaceutically acceptable salt thereof is administered at a dose of about 200 to about 2000 mg, such as a dose of about 200 to about 1600 mg, about 200 to about 1200 mg, about 200 to about 800 mg, about 200 to about 600 mg, or about 200 to about 400 mg.
• Compound (A) or a pharmaceutically acceptable salt thereof is administered at a dose of about 400 to about 2000 mg, such as a dose of about 400 to about 1600 mg, about 400 to about 1200 mg, about 400 to about 800 mg, or about 400 to about 600 mg.
• Compound (A) or a pharmaceutically acceptable salt thereof is administered at a dose of about 25 to about 2000 mg per day, such as a dose of about 50 to about 1200 mg per day or a dose of about 400 to about 800 mg per day or a dose of about 200 to about 400 mg per day. In one embodiment, these daily doses are for oral administration of Compound (A) or a pharmaceutically acceptable salt thereof.
• Compound (A) or a pharmaceutically acceptable salt thereof may be administered as a single dose or in divided doses.
• Compound (A) or a pharmaceutically acceptable salt thereof is administered once daily. In yet another embodiment, Compound (A) or a pharmaceutically acceptable salt thereof is administered twice daily.
• the subject can be a human subject suffering from relapsed peripheral T-cell lymphoma (PTCL), refractory peripheral T-cell lymphoma (PTCL), or relapsed-refractory peripheral T-cell lymphoma (PTCL).
• PTCL peripheral T-cell lymphoma
• PTCL refractory peripheral T-cell lymphoma
• PTCL relapsed-refractory peripheral T-cell lymphoma
• the subject can be a human subject suffering from relapsed cutaneous T-cell lymphoma (CTCL), refractory cutaneous T-cell lymphoma (CTCL), or relapsed-refractory cutaneous T-cell lymphoma (CTCL).
• CTCL relapsed cutaneous T-cell lymphoma
• CCL refractory cutaneous T-cell lymphoma
• CCL relapsed-refractory cutaneous T-cell lymphoma
• Figure 1 is a graph of the percent viability of certain T-lymphoma cell lines (namely, Jurkat, MOLT-4, CCRF-CEM, HuT-78, and HuT-l02 cells) at various concentrations of Compound (A) as measured by the procedure described in Example 2.
• T-lymphoma cell lines namely, Jurkat, MOLT-4, CCRF-CEM, HuT-78, and HuT-l02 cells
• Figure 2 is a graph of the inhibition of Phospho-AKT (pAKT) in T-cell lymphoma cell lines when in the presence of various concentrations of Compound (A) as measured by the procedure described in Example 2.
• Figure 3 is a graph showing the percent induction of caspase-3 activity in T- lymphoma cell lines (namely, Jurkat, MOLT-4, CCRF-CEM, HuT-78, and HuT-l02) at various concentrations of Compound (A) as measured by the procedure described in Example 2.
• Figure 4 is graph showing the percent inhibition of Phospho-AKT (pAKT) in purified malignant T-cells at various concentrations of Compound (A) and LY294002 as measured by the procedure described in Example 3.
• Figure 5 is a bar graph showing the percentage of apoptosis estimated by Annexin V/PI staining in purified malignant T-cells, either untreated or treated with camptothecin or Compound (A) at various concentrations, as measured by the procedure described in Example 3.
• Figure 6 is a graph of tumor volume (mm 3 ) over time in the MOLT-4 Fluman Leukemia Xenograft Model treated with a vehicle, Compound (A) (50 mg/kg/PO/BID) or Ara- C (50 mg/kg), as measured by the procedure described in Example 4.
• Figure 7a is a bar graph showing the response by individual PTCL patients administered with Compound (A) over a dose range of 200 to 800 mg BID according to the procedure described in Example 5. The indicated dosage amounts were administered twice a day (BID).
• Figure 7b is a bar graph showing the response by individual CTCL patients administered with Compound (A) over a dose range of 200 to 800 mg BID according to the procedure described in Example 5. The indicated dosage amounts were administered twice a day (BID).
• Figure 8 is a waterfall plot graph showing the percentage change in nodal size in PTCL and CTCL patients administered with Compound (A) according to the procedure in Example 5.
• the dual selective PI3K delta and gamma inhibitor described herein, including Compound (A) and pharmaceutically acceptable salts thereof, includes the compound which differ only in the presence of one or more isotopically enriched atoms for example replacement of hydrogen with deuterium.
• subject or “patient” encompasses mammals and non-mammals.
• mammals include, but are not limited to, any member of the Mammalian class: humans, non-human primates such as chimpanzees, and other apes and monkey species; farm animals such as cattle, horses, sheep, goats, and swine; domestic animals such as rabbits, dogs, and cats; and laboratory animals including rodents, such as rats, mice and guinea pigs.
• non-mammals include, but are not limited to, birds, and fish.
• the mammal is a human.
• treatment refers to an approach for obtaining beneficial or desired results including but not limited to therapeutic benefit and/or a prophylactic benefit.
• therapeutic benefit is meant eradication or amelioration of the underlying disorder being treated.
• a therapeutic benefit is achieved with the eradication or amelioration of one or more of the physiological symptoms associated with the underlying disorder such that an improvement is observed in the subject, notwithstanding that the subject may still be afflicted with the underlying disorder.
• the compositions may be administered to a patient at risk of developing a particular disease, or to a patient reporting one or more of the physiological symptoms of a disease, even though a diagnosis of this disease may not have been made.
• front-line therapy refers to the first treatment given for a disease. It is often part of a standard set of treatments, such as surgery followed by chemotherapy and radiation. When used by itself, front-line therapy is the one accepted as the best treatment. If it does not cure the disease or it causes severe side effects, other treatment may be added or used instead. It is also called induction therapy, primary therapy, and primary treatment.
• relapsed refers to disease that reappears or grows again after a period of remission.
• Radionuclides e.g., actinium and thorium radionuclides
• LET low linear energy transfer
• beta emitters i.e. beta emitters
• conversion electron emitters e.g. strontium-89 and samarium- 153-EDTMP
• high-energy radiation including, without limitation, x-rays, gamma rays, and neutrons.
• pharmaceutically acceptable refers a material, such as a carrier or diluent, which does not abrogate the biological activity or properties of the compound, and is relatively nontoxic, i.e., the material is administered to an individual without causing undesirable biological effects or interacting in a deleterious manner with any of the components of the composition in which it is contained.
• Pharmaceutically acceptable salts forming part of this invention include salts derived from inorganic bases such as Li, Na, K, Ca, Mg, Fe, Cu, Zn, and Mn; salts of organic bases such as N,N'-diacetylethylenediamine, glucamine, triethylamine, choline, hydroxide, dicyclohexylamine, metformin, benzylamine, trialkylamine, thiamine, and the like; chiral bases like alkylphenylamine, glycinol, and phenyl glycinol, salts of natural amino acids such as glycine, alanine, valine, leucine, isoleucine, norleucine, tyrosine, cystine, cysteine, methionine, proline, hydroxy proline, histidine, ornithine, lysine, arginine, and serine;quaternary ammonium salts of the compounds of invention with alky
• Salts may include acid addition salts where appropriate which are, sulphates, nitrates, phosphates, perchlorates, borates, hydrohalides, acetates, tartrates, maleates, citrates, fumarates, succinates, palmoates, methanesulphonates, benzoates, salicylates, benzenesulfonates, ascorbates, glycerophosphates, and ketoglutarates.
• acid addition salts where appropriate which are, sulphates, nitrates, phosphates, perchlorates, borates, hydrohalides, acetates, tartrates, maleates, citrates, fumarates, succinates, palmoates, methanesulphonates, benzoates, salicylates, benzenesulfonates, ascorbates, glycerophosphates, and ketoglutarates.
• composition refers to a mixture of a compound of the present invention with other chemical components, such as carriers, stabilizers, diluents, dispersing agents, suspending agents, thickening agents, and/or excipients.
• compositions described herein can be administered by various routes of administration including, but not limited to, intravenous, oral, aerosol, parenteral, ophthalmic, pulmonary and topical administration.
• selective inhibition or “selectively inhibit” as applied to a biologically active agent refers to the agent's ability to selectively reduce the target signaling activity as compared to off-target signaling activity, via direct or indirect interaction with the target.
• an "effective amount” or “therapeutically effective amount,” as used herein, refer to a sufficient amount of an agent or a compound being administered which will relieve to some extent one or more of the symptoms of the disease or condition being treated. The result is reduction and/or alleviation of the signs, symptoms, or causes of a disease, or any other desired alteration of a biological system.
• an "effective amount” for therapeutic uses is the amount of a compound of the present invention required to provide a clinically significant decrease in disease symptoms.
• an appropriate "effective" amount in any individual case is determined using techniques, such as a dose escalation study.
• carrier refers to relatively nontoxic chemical compounds or agents that facilitate the incorporation of a compound into cells or tissues.
• compositions include, but is not limited to, any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, one or more suitable diluents, fillers, salts, disintegrants, binders, lubricants, glidants, wetting agents, controlled release matrices, colorants, flavorings, carriers, excipients, buffers, stabilizers, solubilizers, and any combination of any of the foregoing. Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions of the invention is contemplated. Supplementary active ingredients can also be incorporated into the compositions.
• the term“dual PI3-kinase d / g inhibitor” and“dual PI3-kinase d / g selective inhibitor” refers to a compound that inhibits the activity of both the PI3-kinase d and g isozyme more effectively than other isozymes of the PI3K family.
• a dual PI3-kinase d / g inhibitor is therefore more selective for PI3 -kinase d and g than conventional PI3K inhibitors such as CAL-130, wortmannin and LY294002, which are nonselective PI3K inhibitors.
• the relative efficacies of compounds as inhibitors of an enzyme activity can be established by determining the concentrations at which each compound inhibits the activity to a predefined extent and then comparing the results.
• the preferred determination is the concentration that inhibits 50% of the activity in a biochemical assay, i.e., the 50% inhibitory concentration or "IC50".
• IC50 determinations can be accomplished using conventional techniques known in the art. In general, an IC50 can be determined by measuring the activity of a given enzyme in the presence of a range of concentrations of the inhibitor under study. The experimentally obtained values of enzyme activity then are plotted against the inhibitor concentrations used.
• the concentration of the inhibitor that shows 50% enzyme activity is taken as the IC50 value.
• other inhibitory concentrations can be defined through appropriate determinations of activity. For example, in some settings it can be desirable to establish a 90% inhibitory concentration, i.e., IC90.
• the dual PI3-kinase d / g selective inhibitor is a compound that exhibits a 50% inhibitory concentration (IC50) with respect to PI3-kinase d and g, that is at least 10-fold lower, at least 20-fold lower, or at least 30-fold lower than the IC50 value with respect to any or all of the other class I PI3K family members.
• the dual PI3-kinase d / g selective inhibitor is a compound that exhibits an IC50 with respect to PI3-kinase d and g that is at least 30-fold lower, at least 50-fold lower, at least lOO-fold lower, at least 200-fold lower, or at least 500-fold lower than the IC50 with respect to any or all of the other PI3K class I family members.
• a dual PI3-kinase d / g selective inhibitor is typically administered in an amount such that it selectively inhibits both PI3-kinase d and g activity, as described above.
• the compounds of the present invention exhibit PI3- kinase d and g inhibition almost equally ( ⁇ 1 : 1) or at a maximum ratio of 1 :5, i.e., the compound the of the present invention exhibit almost equal IC50 values for both PI3-kinase d and g enzyme , or at most a 3 to 8 fold difference between the two.
• one or more additional active agents can be administered with Compound (A) or a pharmaceutically acceptable salt thereof.
• Compound (A) or a pharmaceutically acceptable salt thereof may be used in combination (administered together or sequentially) with one or more anti-cancer treatments such as, e.g., chemotherapy, radiation therapy, biological therapy, bone marrow transplantation, stem cell transplant or any other anticancer therapy, or one or more cytostatic, cytotoxic or anticancer agents or targeted therapy, either alone or in combination, such as, but not limited to, DNA interactive agents, such as fludarabine, cisplatin, chlorambucil, bendamustine or doxorubicin; alkylating agents, such as cyclophosphamide; topoisomerase II inhibitors, such as etoposide; topoisomerase I inhibitors such as CPT-l l or topotecan; tubulin interacting agents, such as paclitaxel, do
• DNA interactive agents such as fludarabine, c
• B-cell targeting monoclonal antibodies such as belimumab, atacicept or fusion proteins such as blisibimod and BR3-Fc, other monoclonal antibodies such as alemtuzumab and other protein kinase modulators.
• the methods of treatment and uses described herein also include use of one or more additional active agents to be administered with Compound (A), or a pharmaceutically acceptable salt, thereof.
• additional active agents for example, CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone); R-CHOP (rituximab-CHOP); hyperCV AD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine); R- hyperCV AD (rituximab-hyperCV AD); FCM (fludarabine, cyclophosphamide, mitoxantrone); R-FCM (rituximab, fludarabine, cyclophosphamide, mitoxantrone); bortezomib and rituximab; temsirolimus and rituximab; temsirolimus
• the dual selective PI3K delta and gamma inhibitor including Compound (A) and pharmaceutically acceptable salts thereof, may also be used in combination (administered together or sequentially) with one or more steroidal anti-inflammatory drugs, non-steroidal anti-inflammatory drugs (NSAIDs) or immune selective anti-inflammatory derivatives (ImSAIDs).
• NSAIDs non-steroidal anti-inflammatory drugs
• ImSAIDs immune selective anti-inflammatory derivatives
• the dual selective PI3K delta and gamma inhibitor such as Compound (A) or a pharmaceutically acceptable salt thereof, can also be administered in combination with one or more other active principles useful in one of the pathologies mentioned above, for example an anti-emetic, analgesic, anti-inflammatory or anti-cachexia agent.
• the dual selective PI3K delta and gamma inhibitor such as Compound (A) or a pharmaceutically acceptable salt thereof
• a radiation treatment in another embodiment, can be combined with a radiation treatment.
• the compounds and compositions described herein can be administered simultaneously, separately, sequentially and/or spaced in time.
• the dual selective PI3K delta and gamma inhibitors may be any known in the art, such as those described in International Publication No, PCT/IB2014/061954 filed on June 04, 2014 (WO 2014/195888) (including Compound (A)), which is hereby incorporated by reference in its entirety.
• compositions described herein may comprise a dual selective PI3K delta and gamma inhibitor (preferably Compound (A) or a pharmaceutically acceptable salt thereof) and optionally one or more pharmaceutically acceptable carriers or excipients.
• a dual selective PI3K delta and gamma inhibitor preferably Compound (A) or a pharmaceutically acceptable salt thereof
• optionally one or more pharmaceutically acceptable carriers or excipients preferably Compound (A) or a pharmaceutically acceptable salt thereof
• the pharmaceutical composition includes a therapeutically effective amount of a dual selective PI3K delta and gamma inhibitor, such as Compound (A) or a pharmaceutically acceptable salt thereof.
• the pharmaceutical composition may include one or more additional active ingredients, as described herein.
• Suitable pharmaceutical carriers and/or excipients may be selected from diluents, fillers, salts, disintegrants, binders, lubricants, glidants, wetting agents, controlled release matrices, colorants, flavorings, buffers, stabilizers, solubilizers, and any combination of any of the foregoing.
• compositions described herein can be administered alone or in combination with one or more other active agents.
• the dual selective PI3K delta and gamma inhibitor(s) and other agent(s) may be mixed into a preparation or both components may be formulated into separate preparations to use them in combination separately or at the same time.
• compositions described herein can be administered together or in a sequential manner with one or more other active agents.
• the dual selective PI3K delta and gamma inhibitor and other agent(s) may be co-administered or both components may be administered in a sequence to use them as a combination.
• the dual selective PI3K delta and gamma inhibitor and pharmaceutical compositions described herein can be administered by any route that enables delivery of the dual selective PI3K delta and gamma inhibitor to the site of action, such as orally, intranasally, topically (e.g., transdermally), intraduodenally, parenterally (including intravenously, intraarterially, intramuscularally, intravascularally, intraperitoneally or by injection or infusion), intradermally, by intramammary, intrathecally, intraocularly, retrobulbarly, intrapulmonary (e.g., aerosolized drugs) or subcutaneously (including depot administration for long term release e.g., embedded-under the-splenic capsule, brain, or in the cornea), sublingually, anally, rectally, vaginally, or by surgical implantation (e.g., embedded under the splenic capsule, brain, or in the cornea).
• compositions described herein can be administered in solid, semi-solid, liquid or gaseous form, or may be in dried powder, such as lyophilized form.
• the pharmaceutical composition can be packaged in forms convenient for delivery, including, for example, solid dosage forms such as capsules, sachets, cachets, gelatins, papers, tablets, suppositories, pellets, pills, troches, and lozenges.
• solid dosage forms such as capsules, sachets, cachets, gelatins, papers, tablets, suppositories, pellets, pills, troches, and lozenges.
• the type of packaging will generally depend on the desired route of administration.
• Implantable sustained release formulations are also contemplated, as are transdermal formulations.
• the pharmaceutical composition may, for example, be in a form suitable for oral administration as a tablet, capsule, pill, powder, sustained release formulations, solution, suspension, for parenteral injection as a sterile solution, suspension or emulsion, for topical administration as an ointment or cream or for rectal administration as a suppository.
• the pharmaceutical composition may be in unit dosage forms suitable for single administration of precise dosages.
• Oral solid dosage forms are described in, e.g., Remington’s Pharmaceutical Sciences, 20th Ed., Lippincott Williams & Wilkins., 2000, Chapter 89,“Solid dosage forms include tablets, capsules, pills, troches or lozenges, and cachets or pellets”.
• liposomal or proteinoid encapsulation may be used to formulate the compositions (as, for example, proteinoid microspheres reported in U.S. Patent No. 4,925,673).
• Liposomal encapsulation may include liposomes that are derivatized with various polymers (e.g., U.S. Patent No. 5,013,556).
• compositions described herein may include a dual selective PI3K delta and gamma inhibitor and inert ingredients which protect against degradation in the stomach and which permit release of the biologically active material in the intestine.
• the amount of the dual selective PI3K delta and gamma inhibitor, such as Compound (A) or a pharmaceutically acceptable salt thereof, to be administered is dependent on the mammal being treated, the severity of the disorder or condition, the rate of administration, the disposition of the compound and the discretion of the prescribing physician. However, an effective dosage is in the range of about 0.001 to about 100 mg per kg body weight per day, preferably about 1 to about 35 mg/kg/day, in single or divided doses.
• an effective amount of a compound of the invention may be administered in either single or multiple doses (e.g., two or three times a day).
• co-administration encompasses administration of two or more agents to a subject so that both agents and/or their metabolites are present in the animal at the same time.
• Co-administration includes simultaneous administration in separate compositions, administration at different times in separate compositions, or administration in a composition in which both agents are present.
• the dual selective PI3K delta and gamma inhibitor is Compound (A) or a pharmaceutically acceptable salt thereof.
• a further embodiment of the present invention relates to a method of treating peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) comprising administering a therapeutically effective amount of a pharmaceutical composition as described herein to a subject (preferably, a human subject) in need thereof.
• PTCL peripheral T-cell lymphoma
• CTCL cutaneous T-cell lymphoma
• a further embodiment of the present invention relates to the use of a pharmaceutical composition as described herein in the preparation of a medicament for treating PTCL or CTCL.
• the dual selective PI3K delta and gamma inhibitor and pharmaceutical composition may be administered by various routes.
• the dual selective PI3K delta and gamma inhibitor and pharmaceutical composition may be formulated for injection, or for oral, nasal, transdermal or other forms of administration, including, e.g., by intravenous, intradermal, intramuscular, intramammary, intraperitoneal, intrathecal, intraocular, retrobulbar, intrapulmonary (e.g., aerosolized drugs) or subcutaneous injection (including depot administration for long term release e.g., embedded- under the-splenic capsule, brain, or in the cornea), by sublingual, anal, or vaginal administration, or by surgical implantation, e.g., embedded under the splenic capsule, brain, or in the cornea.
• the treatment may consist of a single dose or a plurality of doses over a period of time.
• the uses and methods described herein may involve administering an effective amount of a dual selective PI3K delta and gamma inhibitor (such as Compound (A) or a pharmaceutically acceptable salt thereof) together with one or more pharmaceutically acceptable diluents, preservatives, solubilizers, emulsifiers, adjuvants and/or carriers, as described above.
• a dual selective PI3K delta and gamma inhibitor such as Compound (A) or a pharmaceutically acceptable salt thereof
• Compound (A) was tested across a panel of T-cell lymphoma cell lines (Jurkat, MOLT-4, CCRF-CEM, HuT-78, HuT-l02, Sez4 and HH). Cells were plated in 96-well plates and incubated with desired concentrations of Compound A for 48-72 h. At the end of the incubation period, MTT ((3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide)) was added. The plate was placed on a shaker for 5 min to mix the formazan and the optical density at 560 nM was measured on a spectrophotometer. Data were plotted using Graphpad prism for calculation of the ICso concentrations.
• AKT a serine threonine kinase mediates the downstream effects of PI3K activity and modulates several cell processes including survival and growth.
• Reduction of pAKT by Compound (A) in representative cell lines was determined by Western blotting using a phospho-AKT (Ser 473 ) antibody. Band intensity was measured and quantified using ImageJ software and normalized to actin.
• FACS purified cells from CTCL donors were cultured in RPMI/l0% FBS + 20 ng/ml IL2 + 5 ng/ml IL7 + 10 ng/ml IL15 with and without Compound (A), LY294002, or camptothecin for 48 h.
• Apoptosis was assayed by Annexin V/PI staining.
• the anti-tumor effect of Compound (A) was determined in a MOLT-4 (representing human T lymphoblast cell line) subcutaneous mouse xenograft model. Briefly, 10 6 cells were injected into the flank region. Mice were randomized according to body weight into two groups of five. A week after tumor cell injection, mice either received the vehicle, oral administration of Compound (A) at 50 mg/kg/BID Compound (A), or administration of cytarabine (Ara-C), over an 18-day study period. At the end of the study period, animals were sacrificed and the tumors harvested.
• MOLT-4 human T lymphoblast cell line
• Compound (A) (tenalisib) was given orally twice a day in 28-day cycles and dose-limiting toxicities (DLTs) were assessed during the first cycle.

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• 2018
  • 2018-12-05 AU AU2018378415A patent/AU2018378415A1/en not_active Abandoned
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